Commentary — December 2013
Tex Med. 2013;109(12):7-8.
By Justin Berk
The culture of medicine has changed. Forthcoming ICD-10 codes, meaningful use requirements, and fee-for-service billing dominate medical-industry conversations. Patients are slowly being pushed to the side, replaced by political debates. And physicians are burning out from paperwork and administrative tasks.1
As students, we have noticed this insidious path to disgruntlement. The wearing down of physicians who become bitter, burned out, or tempted away from humanitarianism by high reimbursement rates. Over time, medical students lose their idealism, altruism, and empathy.2-4 As we progress through medical school, particularly in Texas, Osler quotes in the classroom become replaced by Obamacare rants in the wards. Bureaucrats, technology, and increasing health care costs transformed the doctor-patient relationship. Students pick up on the increasing frustration in the profession.
The few oases of "pure" medicine are dwindling. Outside of a handful of rural family docs, the culture of clinics and hospitals focuses on efficiency and cost-effectiveness. As students, we're taught to build rapport expeditiously to save time. We're taught to sit down when talking to patients because sitting creates the perception of having spent more time with them. We're taught to empathetically say, "I'm so sorry to hear about the loss of your father," while quickly moving on to elicit the rest of the patient's family health history.
No compassionate physician supports this cultural change. But the constant escalation of health care costs and the numerous opportunities for profiting shape the new business of medicine. We order more tests, use expensive imaging services, and perform invasive procedures more than any other country in the world.5 Supply has generated demand. And medicine has become less of a public service and more of an industry followed on CNBC and Bloomberg.
Besides the county road clinics, there's another sanctuary of pure medicine without the piles of paperwork. Charitable clinics are unaffected by the darker side of medicine that serves to turn a profit. They exist only to serve. In fact, they are often the first places to offer dedicated care to patients most in need. Other clinics may feel pressured to rush indigent patients out the door. For many patients suffering with chronic illnesses, free clinics may be the first — or only — place that devotes the time and has the ability to treat them well.
As a student at the Texas Tech University Health Sciences Center (TTUHSC) School of Medicine, I've experienced this pure medicine at our student-run free clinic. There's no billing, no paperwork, and no electronic records. At the student-run free clinic, you find only compassionate physician volunteers, eager young students, and patients needing care.
After visiting with students, physicians, and pharmacists to gain a greater understanding of their diseases, many patients recount how empowered they feel. Through grateful tears, patients have shown newfound eagerness to improve their health. They begin to exercise, reduce their sodium intake, avoid white carbs, and begin to stop smoking. Our greatest successes are not generated from prescribed antibiotics. Instead, they come from a sympathetic ear and a compassionate touch.
Thankfully, student-run clinics and more than 1,200 other charitable clinics around the nation serve patients regardless of income or insurance status. And the benefits are clear. Charitable clinics improve patient care by addressing chronic issues early, provide a much-needed alternative to overcrowded emergency rooms, and often bring hospitals, schools, nonprofits, and other leaders together to address a community need.
In Texas, the community need is desperate. Texas has the highest rate of uninsured in the country: 26 percent of adults and 22 percent of children.
Unfortunately, the Lubbock Impact/TTUHSC Free Clinic, like other charitable clinics around the nation, is constantly at capacity.
Lack of access to health care is not a partisan issue. It's a state and national problem that harms us all. Without access to care, costs increase due to more complicated issues, ER waiting rooms become crowded because there is no where else to go, and the spread of disease increases when illnesses go untreated. Neither the Affordable Care Act nor its repeal will ensure that families are able to obtain the care they need. Political debates surrounding health care will continue and will likely only grow fiercer.
For students and physicians alike, these issues are not why we entered medicine. We're here to help, to heal, and to listen to our patients in need. As Osler said, "We are here to add what we can to life, not get what we can from life."
Clinics like the Lubbock Impact/TTUHSC Free Clinic offer a venue to practice medicine in this way. Charitable clinics serve not only the patients, but also the health care providers. They remind students (and physicians) why they entered medicine. In a community clinic, the focus returns to the patient, his or her hardships, and building relationships. Patients aren't just charts, illnesses, or billing codes. They are the humanistic story of why we became doctors.
My education at the clinic was not on health care reform or reimbursement codes. It was where I heard my first breath sounds, caught my first murmur, and wrote my first SOAP note. The clinic provides much more than education. Most importantly, it provides inspiration. Our experiences regularly remind us why we study constantly, spending our youth nose-in-book. I'm not only learning about diabetes treatments; I'm also learning about the doctor I hope to become and the medicine I hope to practice.
My experience is not unique. At least 50 medical schools have student-run clinics, where students engage in patient care early in their careers.6 But student-run free clinics are in a permanently precarious position. They do not sustain themselves; they rely on the constant support of institutions, individual donors, volunteers, and advocates across our society.
Whether a physician, a student, a donor, or a community member with a voice, each of us can make an effort to encourage an environment that centers on the patient. Student-run free clinics shape the future of medicine for the better and, in the meantime, provide health care to those most in need, those who would otherwise go without it.
Within these clinics, all involved — medical students, nurses, physicians, and patients alike — constantly see the humanitarian reasons for joining the medical field. Here, we still have an oasis: a pure form of medicine.
Justin Berk is a third-year student at the Texas Tech University Health Sciences Center School of Medicine in Lubbock. He will receive his medical degree in 2015.
- Feldman MD. From the editors' desk: physician heal thyself. J Gen Intern Med. 2011;26(8):823. doi: 10.1007/s11606-011-1755-0.
- Chen D, Lew R, Hershman W, Orlander J. A cross-sectional measurement of medical student empathy. J Gen Intern Med. 2007;22(10):1434-1438. doi:10.1007/s11606-007-0298-x.
- Woloschuk W, Harasym PH, Temple W. Attitude change during medical school: a cohort study. Med Educ. 2004;38(5):522-534. doi:10.1046/j.1365-2929.2004.01820.x.
- Griffith CH III, Wilson JF. The loss of student idealism in the 3rd-year clinical clerkships. Eval Health Prof. 2001;24(1):61-71.
- Bradley E, Taylor L. More medical care: the wrong prescription for health reform. Everyday Health. 2013. http://www.everydayhealth.com/heart-health/more-medical-care-the-wrong-prescription-for-health-reform-3589.aspx.
- Simpson SA, Long JA. Medical student-run health clinics: important contributors to patient care and medical education. J Gen Intern Med. 2007;22(3):352-356. doi: 10.1007/s11606-006-0073-4.
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